Targeted Versus Population-Based Screening as a Primary Preventive Approach Towards Gastric Cancer: Interim Results of the Irish Experience

Expectations for and challenges in population-based endoscopic gastric and colorectal cancer screening.

Objectives: To investigate the real-world outcomes of a population-based gastric cancer (GC) screening program in Kawasaki City, a major urban area with a growing aging population and relatively high screening participation rates. Methods: Between December 2012 and 2021, a total of 337,842 citizens in Kawasaki City underwent population-based GC screening, leading to the detection of 1087 GC cases. Esophageal cancer (EC) has been recorded since 2016, with 236 cases detected. To evaluate the short- and long-term clinical outcomes of screening-detected GC and EC, we conducted a retrospective study using the electronic medical records of patients treated at our hospital, a high-volume institution for GC and EC treatment in the city. As a control group, we included 34 GC and EC cases diagnosed based on symptoms at our hospital in 2018. Results: Among the 1087 GC cases detected through population-based screening, 102 cases treated at our hospital were included in the analysis. Of them, 91 patients (89%) were diagnosed with early-stage GC. All screening-detected GC cases underwent either surgery (27 cases) or endoscopic submucosal dissection (75 cases). The five-year survival rates for GC were 90% in males and 86% in females. Eighteen EC cases were also included in the study. The five-year survival rate for screening-detected advanced GC was 70.0%, while for screening-detected EC, it was 100%. Both survival rates were significantly higher than those for symptom-diagnosed GC (30.0%) and EC (40.8%). Conclusions: The prognosis of GC and EC detected through population-based endoscopic screening is significantly better than that of cancers diagnosed based on symptoms. This underscores the effectiveness of endoscopic screening as a valuable tool for the early detection of upper gastrointestinal tract cancers.

Assessing the impact that patterns of Na intake may have on gastric cancer will provide a more comprehensive estimation of Na reduction as a primary prevention approach. We aimed to estimate the proportion of gastric cancer cases that are attributable to Na intake above the recommendation by the WHO (≤2 g/d) throughout the world in 2010, as well as expected values for 2030. Population attributable fractions (PAF) were computed for 187 countries, using Na intakes in 1990 and 2010 and estimates of the association between Na intake and gastric cancer, assuming a time lag of 20 years. Median PAF ranged from 10·1% in low to 22·5 % in very high Human Development Index (HDI) countries in men (P<0·001) and from 7·2 to 16·6 %, respectively, among women (P<0·001). An increase in median PAF until 2030 is expected in most settings, except for countries classified as low HDI, in both sexes. High Na intakes account for a large proportion of gastric cancer cases, and proportions are expected to increase in almost all of the countries. Intensified efforts to diminish Na intake in virtually all populations are needed to further reduce gastric cancer burden.

Gastric cancer (GC) is the second leading cause of cancer death in China. It is well known that Cixian in Hebei Province is one of the highest risk areas of GC in China and worldwide. This study aims to accurate assessment of GC burden and trend in high-risk area (Hebei Province) from 1973 to 2013. The authors analyzed GC data from 21 population-based cancer registries which represented 15.25% of the entire population of Hebei Province. The collected data were stratified by 5-year age groups, gender, and area. Mortality of GC was extracted from national death surveys from 1973 to 1975, 1990 to 1992, 2004 to 2005, and 2011 to 2013. Trend analysis (1988-2013) in a high-risk area (Cixian) used the Joinpoint Model. The age-period-cohort model was used to estimate the effects of age, period, and birth cohort in GC incidence in Cixian from 1988 to 2013. The crude incidence of GC in 2011 to 2013 was 40.37/100,000 (57.53/100,000 in males and 22.55/100,000 in females). The corresponding age-standardized rate by world age-standard population was 32.18/100,000 (48.87/100,000 in males and 17.53/100,000 in females), which was 2.66-fold (2.81-fold in male and 2.34-fold in female) higher than that in the world (12.1/100,000, 17.4/100,000 in males and 7.5/100,000 in females). Males in rural areas had the highest incidence, with an age-standardized rate of 70.51/100,000. Gastric cardia cancer was primary anatomical subsite which accounting for 59.59% in GC, followed by gastric corpus (13.92%), gastric antrum (11.43%), gastric fundus (4.99%), and overlapping lesion of gastric (4.17%). The age-standardized rate of mortality from GC displayed a significant downward trend (P = 0.019) in Hebei Province from the 1990s (31.44/100,000) to the 2010s (24.63/100,000). In Cixian, the incidence of GC rose from 1988 (38.25/100,000) to 2009 (65.11/100,000). Cixian, where population-based screening of upper gastrointestinal cancer was performed, experienced the increasing rate of GC from 2000 (37.59/100,000) to 2009 (65.11/100,000) and then had a sharp decrease from 2009 to 2013 (55.30/100,000), with annual percentage change of -6.69%. Gastric cardia cancer had an increasing trend from 1988 (6.88/100,000) to 2013 (26.56/100,000). Both age and birth cohort effects played important roles in these changes. In conclusion, males in rural areas had the highest risk of GC. GC mortality rate decreased from the 1990s in Hebei Province. Endoscopic screening project for GC is an effective method of controlling the disease.

While the health field has clearly made the case for the detrimental effects of child sexual abuse and exploitation, the responses to the problem have largely focused on after-the-fact actions...

Adolescents exhibit a high rate of use of alcohol and illicit drugs. Effect studies rarely describe the actual content of the interventions in detail. Less is known about what was actually done in the prevention than about their effects.Aim: This study is a review study grouping the qualitatively different content components of the various approaches into five categories. Methods: A systematic literature review from Western countries on the topic of school-based interventions and prevention initiatives targeting young people aged 12–20. A modified version of the narrative synthesis approach is used for analysis. The sample consisted of 33 peer-reviewed articles published between January 2010 and December 2014. Findings: Five categories of intervention and prevention programmes were identified: ‘Information-based or testing-based primary prevention approaches’, ‘Primary prevention approaches incorporating skill-training components’, ‘Universal or primary prevention approaches that include family components’, ‘Targeted approaches incorporating skill-training components’, and ‘Approaches incorporating digital features’. Conclusion: Only four studies that employed any form of targeting or profiling of the subjects prior to the delivery of the prevention intervention or initiative were identified. The skewness towards primary prevention skill-training approaches should be addressed, given the diverse consumption patterns among adolescents.

Background: The global burden of cancer continues to increase largely because of the aging and growth of the world population alongside an increasing adoption of cancer-causing behaviors, particularly smoking, in economically developing countries. Cancer (CA) is an increasing public health burden for Ethiopia and Sub- Saharan Africa at large. In Ethiopia, hospital records show that there are more than 150,000 cancer cases per year and currently cancer accounts for 4% of all deaths. Objective: The present prospective cross-sectional study was designed to assess the prevalence of cancer and its associated risk factors in patients visiting Tikur Anbessa Specialized Hospital (TASH). Methods: A prospective cross-sectional study was carried out in patients of all age groups visiting oncology unit of TASH during the study period of November 2015 to June 2016. Sample size was computed using margin of error 5%, confidence level of 95% and estimating cancer patients visiting TASH per annum equal to 20000. The response distribution was taken 10%, considering the 2012 Cancer Prevalence Report of the WHO in East Africa 5% to 10%. The calculated sample size then was 142. Result and discussion: The mean age of the participants in our study was 42.27 year with a standard deviation of 16.8, and 2 and 86 years were the age range. More than half of the patients in the study (61.3%, n=87) were females and about (38.7%, n=55) were males. In the study area uterine, breast, cervical, colorectal and gastric CA were more prevalent in the age group between 25-49 years while Acute Lymphoblastic Leukemia (ALL) was more common in 13-18 years of age, Ewing sarcoma was seen in age between 19 and 24 years. In our findings, breast CA (14.8%, n=21) was the most frequent type of CA followed by uterine CA (14.1%, n=20), colorectal CA (11.3%, n=16), gastric cancer CA (7.7%, n=11), cervical and esophageal cancers (7%, n=10). ALL was commonly seen in students, while gastric, lung, AML, osteosarcoma; and squamous cell CA were common in farmers. Furthermore, among 20 patients who had breast CA, 65% (n=13) were used contraceptives at least once in their last 10 years period, while uterine cancer patients (40%, n=8) were used either oral or injectable contraceptives. The prevalence of breast CA was not affected by the duration of contraceptive use rather it was stable across the duration of use. Many patients who were developed colorectal CA 12 (8.5%) and gastric CA 9 (6.3%) were reported that they were regularly consuming uncooked red meat as their favorite meal. In our study, many patients were receiving radiation therapy for cases such as uterine, breast, cervical and colorectal CA while chemotherapy was predominantly used in cases such as colorectal, squamous cell, osteosarcoma, ALL, AML and lung cancer. The multinomial regression analysis result further revealed that there was a significant association between breast CA with age (25-49 year, P. value 0.016), Uterine and Cervical CA with gender (female, P. value 0.001); and eating of uncooked red raw meat with colorectal CA (P. value 0.011). Conclusion: Cancer prevalence in the study area looks greatly jeopardizing the life of many Ethiopians in association with life styles. Hence, further studies should be done. Awareness creation programs to the people, allocation of public health preventive medicine approaches and in-depth governmental involvement in the area are highly needed.

Results of a Population-Based Gastric Cancer Screening Program Conducted in Chile 1996-2008

History of conventional endoscopy for gastric evaluation in Japan.

Gastric cancer remains a major cancer problem world-wide and future incidence will likely increase due to rapidly aging population demographics. Population-based screening is being undertaken in Korea and Japan, where gastric cancer incidence rates are high, and seems to be effective in reducing mortality from gastric cancer. However, such strategies are difficult to implement in countries with a low incidence or limited resources. Thus, screening strategies should be directed towards high-risk population subgroups. Gastric cancer has a relatively long mean sojourn time, and prognosis of early-stage disease is excellent. In general population, screening at 2-year interval in Korea seems to be effective for early-stage diagnosis. In subjects with atrophic gastritis or intestinal metaplasia, surveillance is recommended at 1 to 3 years intervals according to European and Japanese recommendation. Screening intervals for family members with sporadic gastric cancer has not yet been adequately evaluated, but 1-year interval is recommended for hereditary diffuse gastric cancer family-members. Gastric cancer patients treated by endoscopic resection are the highest-risk group, and 1-year interval surveillance can detect most metachronous gastric cancers at an early stage. Future gastric cancer surveillance strategies using endoscopy should be guided by risk-stratification assessment, and further refinement of optimal surveillance intervals is needed.

Background: Gastric cancer is a heterogeneous malignant disease associated with environmental and genetic predisposing factors. While gastric cancer incidence and mortality fell greatly globally over the past decades, it remains the fourth cause of cancer-related death worldwide. Thus, prevention of gastric cancer is still a major strategy for improvement of gastric cancer prognosis. Summary:Helicobacter pylori infection has been demonstrated to be a major risk factor for the development of gastric cancer. Unhealthy diet and lifestyle, including high-salt food, smoking and drinking, are able to induce genotypic and phenotypic transformation of gastric epithelial cells. Gene mutations (such as E-cadherin) in stomach epithelial cells are major genetic causes for gastric cancer. The eradication of H. pylori has been demonstrated to be an effective approach for primary prevention of gastric cancer. Increased intake of a diet rich in vegetables and fresh fruits as well as smoking cessation have been shown to reduce the incidence of gastric cancer. The secondary prevention strategy is to screen premalignant gastric lesions by endoscopy. Biomarker tests are also reliable methods to identify gastric precancerous lesions. Endoscopy screening is still the gold standard for diagnosis of gastric cancer. Key Message:H. pylori infection, a diet rich in salted and/or smoked food and red meat, as well as gene mutations are major risk factors for the development of gastric cancer. Practical Implications: The eradication of H. pylori is a major primary preventive strategy of gastric cancer. A healthy lifestyle, including increased intake of a diet rich in fruit and vegetables, reduced intake of salted and smoked food and red meat, a reduction of alcohol intake as well as smoking cessation will be effective approaches for the prevention of gastric cancer.

Isolated impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are two risk categories for type 2 diabetes. This study compared both categories with respect to the degree of insulin secretion abnormalities and insulin resistance. This is a crossover comparison of a population at high risk for type 2 diabetes. The subjects were recruited from the Risk Factor in Impaired Glucose Tolerance for Atherosclerosis and Diabetes (RIAD) study. They underwent a 75-g oral glucose tolerance test, with measurement of specific insulin, C-peptide, proinsulin, and free fatty acids at baseline and every 30 min after load for 2 h. Factor analysis was performed to evaluate the importance of insulin resistance and secretion abnormalities in both categories. All categories of prediabetic hyperglycemia had a higher cardiovascular risk factor level when adjusted for sex, age, and BMI compared to control subjects with normal glucose tolerance. Subjects with isolated IFG were more insulin resistant than those with IGT. By contrast, subjects with isolated IGT exhibited a more severe deficit in early- and late-phase insulin secretion versus IFG subjects. As shown with factor analysis, in IFG the insulin resistance factor explained 28.4% of the variance, whereas in IGT the insulin secretion factor was dominant, explaining 31.1% of the total variance. Our cross-sectional data from the RIAD study demonstrate that isolated IFG and isolated IGT are different with respect to the degree of insulin resistance and anomalies in insulin secretion, and that subjects with IGT exhibit a deficit in the early and late phases of insulin secretion. This finding may be important for a differential approach in primary prevention of type 2 diabetes.

We performed a systematic review with network meta-analysis (NMA) to compare the efficacy of different approaches in primary prevention of esophageal variceal bleeding and overall survival in patients with cirrhosis with large varices. Thirty-two randomized clinical trials (RCTs) with 3,362 adults with cirrhosis with large esophageal varices and no prior history of bleeding, with a minimum of 12 months of follow-up, were included. Nonselective beta-blockers (NSBB), isosorbide-mononitrate (ISMN), carvedilol, and variceal band ligation (VBL), alone or in combination, were compared with each other or placebo. Primary outcomes were reduction of all-cause mortality and prevention of esophageal variceal bleeding. Random-effects NMA was performed and summary estimates were expressed as odds ratio and 95% confidence intervals (OR; CI). Quality of evidence was critically appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. Moderate quality evidence supports NSBB monotherapy (0.70; 0.49-1.00) or in combination with VBL (0.49; 0.23-1.02) or ISMN (0.44; 0.21-0.93) for decreasing mortality in patients with cirrhosis with large esophageal varices and no prior history of bleeding. Moderate-quality evidence supports carvedilol (0.21; 0.08-0.56) and VBL monotherapy (0.33; 0.19-0.55) or in combination with NSBB (0.34; 0.14-0.86), and low-quality evidence supports NSBB monotherapy (0.64; 0.38-1.07) for primary prevention of variceal bleeding. VBL carries a higher risk of serious adverse events compared with NSBB. Conclusion: NSBB monotherapy may decrease all-cause mortality and the risk of first variceal bleeding in patients with cirrhosis with large esophageal varices. Additionally, NSBB carries a lower risk of serious complications compared with VBL. Therefore, NSBB may be the preferred initial approach for primary prophylaxis of esophageal variceal bleeding.

IssueMigrants have suboptimal vaccination coverage compared to the general population in destination countries due to several factors -administrative barriers or lack of legal entitlements to health-health system barriers (language, lack of cultural sensitivity and community engagement capacity, vaccination costs)-lack of trust in the health system and misconceptions about vaccines due to misinformation or beliefs ProblemCountries should develop national policies and ensure an inclusive, free of charge and proactive vaccination offer to migrants, irrespective of their legal status; and to extend this approach beyond the current pandemic and the sole COVID-19 vaccineResultsTo achieve COVID-19 global herd immunity all population groups, including migrants, needs to access vaccination. Tailored vaccination strategies, once devised, shall be applied to routine national vaccination plan to tackle health inequalitiesLessonsThe following actions shall be implemented at national levelAction 1. Develop tailored and equitable approaches for PH vaccination services targeting migrants through: -free of charge access-decentralization and outreach capacity of the health system-innovative service delivery models (mobile clinics, combined health services, mass vaccination)-health personnel and migrants participatory approach and engagement strategies Action 2. Increase staff engagement through: -increasing health personnel's difference sensitivity-strengthening health personnel's communication capacitiesAction 3. Increase migrants' health and vaccine literacy through: -establishing vaccine literacy education programmes and strategies-offering health promotion educational interventions Action 4. Monitor progress of inclusive vaccination offer by: -setting strategic goals, targets and indicators for national vaccination plans-expanding immunization information systems to monitor vaccination coverage, with appropriate disaggregation by migration status core variablesKey messages Explicitly and proactively include migrants and displaced communities in vaccination plans and set up, test and implement new approaches in primary prevention and vaccination services.Extend this approach beyond the current pandemic and the sole COVID-19 vaccine in order to enhance preparedness to present and future health threats.

Background: Lipoprotein(a) [Lp(a)], remnant cholesterol (RC), and high-sensitivity C-reactive protein (hsCRP), a marker of systemic inflammation, are emerging non-traditional biomarkers for cardiovascular (CV) risk stratification and treatment guidance. Each of these biomarkers may reflect a distinct but complementary pathway contributing to atherosclerosis and cardiovascular disease (CVD). Therefore, an approach that combines all three may improve the predictive power for CV risk assessment. Research Question: To what extent does a multi-marker approach combining Lp(a), RC, and hsCRP improve prediction of first myocardial (MI) compared to the use of each biomarker individually? Methods: We analyzed data from 306,183 participants in the UK Biobank who were free of CVD at baseline and had available measurements for Lp(a), RC, and hsCRP. RC was calculated as total cholesterol minus LDL-C and HDL-C. We examined the cumulative effect of biomarker burden, defined as the number of biomarkers in the highest quintile (0 to 3). We also used Cox proportional hazards models to assess hazard ratios (HRs) and 95% confidence intervals (CIs) for MI risk across biomarker quintiles, adjusted for conventional CV risk factors and the other two biomarkers. Results: The mean baseline age was 56.4 years; 54.7% were women. Over a 15-year median follow-up, 10,824 MI events occurred (3.5%). There was a graded increase in MI incidence with a rising number of biomarkers in the top quintile (Figure). Adjusted HRs for MI comparing the top versus bottom quintiles were 1.09 (95% CI: 1.08–1.11) for Lp(a), 1.14 (1.13–1.16) for RC, and 1.08 (1.06–1.10) for hsCRP. Relative to individuals with no biomarkers in the top quintile, HRs for MI among those with one, two, or all three biomarkers in the top quintile were 1.45 (1.39–1.51), 2.14 (2.02–2.26), and 2.83 (2.48–3.24), respectively (Table).: Conclusions: Among adults in the UK Biobank without baseline CVD, a multi-marker approach incorporating lipoprotein(a), remnant cholesterol, and high-sensitivity C-reactive protein was associated with a stepwise increase in first myocardial infarction risk corresponding to greater biomarker burden. These findings support the potential value of integrative risk stratification approaches in primary prevention. Further research is warranted to determine whether this multi-marker strategy can inform treatment decisions or improve outcomes.